legg calve perthes

• related: Pediatric

• pt:

  • 4-8 years, male predominant
  • higher risk with FHx, low birth weight, 2nd hand smoking

• cause: idiopathic avascular necrosis of the femoral head. Interruption of the blood supply by a currently unknown cause.

• symptoms:

  • slow onset
  • gradual painless limp
  • intermittent knee, hip, groin, thigh pain

• dx

  • Hip stiffness with loss of internal rotation and abduction
  • Gait disturbance
  • Limb length discrepancy (late disease finding)

• x ray finding:

  • Medial joint space widening (earliest finding)
  • Small femoral head due to irregularity of the femoral head ossification center
  • Subchondral fracture

• rx:

  • treatment strategy is containment of the hip within the acetabulum by either bracing or surgical means.
  • Operative treatment is indicated in children over age 8 or in cases of permanent hip dysplasia, and involves acetabular reconstruction

• complications

  • Osteoarthritis
  • Progressive avascular necrosis
  • Early arthroplasty in cases of permanent dysplasia.,